REVIEW ARTICLE

A Systematic Review of School-Based Interventions

to Prevent Bullying
Rachel C. Vreeman, MD; Aaron E. Carroll, MD, MS

Objective: To conduct a systematic review of rigorously evaluated school-based interventions to decrease

bullying.
Data Sources: MEDLINE, PsycINFO, EMBASE, Educational Resources Information Center, Cochrane Collaboration, the Physical Education Index, and Sociology: A SAGE Full-Text Collection were searched for the
terms bullying and bully.
Study Selection: We found 2090 article citations and
reviewed the references of relevant articles. Two reviewers critically evaluated 56 articles and found 26 studies
that met the inclusion criteria.
Interventions: The types of interventions could be categorized as curriculum (10 studies), multidisciplinary or
whole-school interventions (10 studies), social skills
groups (4 studies), mentoring (1 study), and social worker
support (1 study).
Main Outcome Measures: Data were extracted
regarding direct outcome measures of bullying (bullying, victimization, aggressive behavior, and school

responses to violence) and outcomes indirectly related

to bullying (school achievement, perceived school
safety, self-esteem, and knowledge or attitudes toward
bullying).
Results: Only 4 of the 10 curriculum studies showed
decreased bullying, but 3 of those 4 also showed no improvement in some populations. Of the 10 studies evaluating the whole-school approach, 7 revealed decreased
bullying, with younger children having fewer positive effects. Three of the social skills training studies showed
no clear bullying reduction. The mentoring study found
decreased bullying for mentored children. The study of
increased school social workers found decreased bullying, truancy, theft, and drug use.
Conclusions: Many school-based interventions directly reduce bullying, with better results for interventions that involve multiple disciplines. Curricular changes
less often affect bullying behaviors. Outcomes indirectly related to bullying are not consistently improved
by these interventions.

Arch Pediatr Adolesc Med. 2007;161:78-88

Author Affiliations: Childrens

Health Services Research,
Indiana University School of
Medicine (Drs Vreeman and
Carroll), and The Regenstrief
Institute for Health Care
(Dr Carroll), Indianapolis, Ind.

ULLYING IS A FORM OF AGgression in which 1 or more

children repeatedly and intentionally intimidate, harass, or physically harm a
victim.1 Victims of bullying are perceived
by their peers as physically or psychologically weaker than the aggressor(s), and victims perceive themselves as unable to retaliate.2 Although bullying, harassment,
and victimization can take many forms, the
key elements of this behavior are aggression, repetition, and the context of a relationship with an imbalance of power.3
Bullying can impact the physical, emotional, and social health of the children
involved. Victims of bullying more often
report sleep disturbances, enuresis, abdominal pain, headaches, and feeling sad
than children who are not bullied.4,5 Bullies, their victims, and those who are both
bullies and victims have significantly in-

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

78

creased risk for depressive symptoms and

suicidal ideation.6,7 Students who report
victimization are 3 to 4 times more likely
to report anxiety symptoms than uninvolved children.8,9 The effects of bullying
on emotional health may persist over time;
1 study10 showed that children bullied repeatedly through middle adolescence had
lower self-esteem and more depressive
symptoms as adults. Victims of bullying
are more likely to feel socially rejected or
isolated and to experience greater social
marginalization and lower social status.11
Bullying impacts a childs experience of
school on numerous levels. Bullying creates problems with school adjustment and
bonding, affecting the victims completion of homework or desire to do well at
school.6,12 In 1 study,13 20% of gradeschool children reported being frightened through much of the school day. Bullying seems to increase school absenteeism,

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

with victimized children becoming more school avoidant as the victimization increases.14 Furthermore, involvement in bullying affects academic performance, although studies15-18 show mixed results regarding which
children are most affected. Most bullying takes place at
school, particularly at times and places where supervision is minimal.19 Schools where adults tolerate more bullying may have more severe bullying problems.10
As school bullying increasingly becomes a topic of public concern and research efforts, a growing number of studies examines school-based interventions targeted to reduce bullying. Although many of these interventions have
been rigorously evaluated, the evaluations reveal mixed
results.20 For example, evaluations of the Olweus Bullying Prevention Program, a comprehensive wholeschool intervention on which many subsequent programs have been based, report reductions of 30% to 70%
in the student reports of being bullied and bullying others.2,20-22 In contrast, evaluation of a similar comprehensive prevention program implemented in Belgium did not
show significant differences in victimization or bullying
scores among primary or secondary school students.23 Although some review articles have described several of these
interventions, to our knowledge, no systematic reviews
of interventions to reduce bullying have been published
in peer-reviewed literature. The objective of this study
was to review rigorously evaluated school-based interventions to reduce or prevent bullying with the goal of
determining whether these interventions worked.
METHODS
We searched several bibliographic databases, including MEDLINE
(January 1, 1966, through August 23, 2004), PsycINFO, EMBASE,
Educational Resources Information Center, the Physical Education Index, Sociology: A SAGE Full-Text Collection, and the
Cochrane Clinical Trials Registry (all as of August 23, 2004).
We used the search terms bullying or bully as Medical Subject
Headings or keywords. We used a keyword search because it
was more robust than searches using only Medical Subject Headings. One of us (R.C.V.) reviewed the titles of all returned articles and the bibliographies of all relevant review articles to
determine which studies examined a school-based intervention to prevent or reduce bullying. Articles were immediately
excluded if they obviously did not include an intervention or
did not occur at a school.
After articles that clearly did not meet the inclusion criteria were excluded, both of us (R.C.V. and A.E.C.), blinded to
the journal citation and article text other than the Methods
section, independently reviewed the articles. The 2 reviewers
independently decided on trial inclusion using a standard form
with predetermined eligibility criteria. Disagreements were resolved by consensus reached after discussion. For inclusion, a
study needed to describe an experimental intervention with control and intervention groups and to include a follow-up evaluation with measured outcomes. In addition, the intervention
needed to be school based and designed to reduce or prevent
bullying. Each article was analyzed to determine the study
method, intervention components, outcomes measured, and results. There was no assessment of quality in choosing or evaluating study outcomes beyond the inclusion criteria. We did not
exclude or discount studies based on baseline similarities among
treatment groups, study power, retention rates, or program intensity because these characteristics are not associated defini-

tively with the strength of treatment effects.24 Duplicate publications or multiple articles that reported identical outcomes
measured over the same period on the same population were
excluded.
We extracted data from the selected articles regarding direct outcome measures of bullying, including bullying, victimization, aggressive behavior, violence, school responses to violence, and violent injuries. Data were also extracted for outcomes
thought to be indirectly related to bullying, such as school
achievement, perception of school safety, self-esteem, or knowledge about or attitudes toward bullying.
RESULTS

The systematic literature search identified 2090 articles.

The online search of MEDLINE yielded 353 articles,
and the search of EMBASE yielded 269 articles, 9 of
which were not found by the MEDLINE search. The
search of PsycINFO yielded 897 articles, Educational Resources Information Center yielded 552 articles, the Physical Education Index yielded 16 articles, and Sociology: A
SAGE Full-Text Collection yielded 3 articles. An additional 4 potential studies25-28 were identified through
searches of bibliographies and were also reviewed. Once
articles that obviously did not address school-based interventions were excluded, 321 relevant articles remained. Reviewing the abstracts of these articles allowed
for the further exclusion of articles that did not address
school-based interventions. Fifty-six articles were then assessed by both of the reviewers. Articles were most commonly excluded at this stage because they were not evaluations of interventions, they did not have control groups,
or they did not address bullying.
The 26 studies that met the selection criteria varied
substantially in intervention type, study population, study
design, and outcome measures. The detailed characteristics of the studies are reported in Table 1. The interventions could be divided into 5 categories: curriculum
interventions, multidisciplinary or whole-school interventions, targeted social and behavioral skills groups, mentoring, and increased social work support. To maximize
clarity and clinical usefulness, we present the subsequent results of the review based on the type of intervention. All 26 studies investigated interventions for some
group of primary school students, but the primary grade
levels varied from first to eighth grade. Six studies22,23,30,39,41,48 included secondary school students (older
than eighth grade) in their interventions and outcomes.
The selected studies reported a range of outcomes that
were subsequently categorized into direct and indirect
outcomes. The direct and indirect outcomes of all of the
studies are reported in Table 2.
CURRICULUM INTERVENTIONS
Ten studies23,26,29-36 evaluated the implementation of new
curriculum. The curriculum interventions included videotapes, lectures, and written curriculum, and varied in
intensity from a single videotape followed by classroom
discussion to 15 weeks of classroom modules. The details of the study designs, participants, intervention type,
and important outcomes of the curriculum interven-

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

79

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

Table 1. Study Characteristics

Source
Baldry and
Farrington,29
2004
Boulton and
Flemington,30
1996

Country

Subjects

Control
Group

Intervention
Group

Grade Level
or Age
Group

Study
Design

Educational
Theory*

Intervention

Curriculum Interventions
239 students
106 students 131 students
Aged 10-16 y Pretest,
in 10 classes
posttest,
randomized,
controlled
trial
United
170 students
4 classes
4 classes
Grades 7-10 Randomized
Kingdom
in 8 classes
(aged
matched
at 1 school
11-14 y)
pairs
Italy

Cowie et al,26
1994

United
2 schools,
5 classes
Kingdom
16 classes,
148 students

11 classes

Aged 7-12 y

Elliott and
Faupel,31
1997

United
64 students
Kingdom

32 students

32 students

Grades 4
and 5

Englert,32
1999

United
States

71 students
in 3 classes

23 students
(1 class)

Kaiser-Ulrey,33
2003

United
States

125 students

67 students

24 students in the Grade 4

problemsolving group
(1 class) and
24 students in
the cooperative
task group
(1 class)
58 students
Grade 7

Rican et al,34
1996

Czechoslovakia

198 students
in 8 classes

98 students

100 students

Stevens
et al,23
2000

Belgium

24 schools
total (728
primary
school
students and
1465
secondary
school
students)

Teglasi and
Rothman,35
2001

United
States

59 students: 17
aggressive
and 42
nonaggressive

Warden
et al,36
1997

United
120 students
Kingdom
in 6 schools

3-d intervention Social cognitive

program
competence
(3-h sessions,
skills
once a week,
for 3 wk)
Short videotaped Not given
intervention
(Sticks and
Stones) with
class
discussion
Pretest,
Cooperative
Cooperative
posttest,
group work
group work,
control group
curriculum
effect on
design
interpersonal
relationships
Pretest,
Videotape and
Group
posttest,
curriculum
interpersonal
randomized,
problem
controlled
solving
trial
Pretest,
2 curricula: one in Problem-solving
posttest,
problemand
control group
solving training
cooperative
design
and one in
task
cooperative
development
task
development

Pretest,
12-wk
posttest,
antibullying
control group
curriculum
design

Method
of Group
Assignment
Random
allocation by
class
One class in
each year
randomized
to the
intervention
group
Schools selected
based on
interest
Randomized by
student

Assigned by class

Psychoeducation, Assigned in
empathy,
cohort groups
problemsolving,
dissemination
Not given
Assigned by class

Grade 4
Pretest,
Videotape,
(median
posttest,
curriculum
age, 10 y)
control group
changes,
design
class charter
193 primary 130 primary
Primary and Pretest,
Videotape,
Social cognitive Randomly
school
school
secondary
posttest,
curriculum
orientation
assigned by
students
students and
schools
randomized,
changes,
emphasizing
school to
and 229
219 secondary
controlled
class charter,
cognitive
experimental
secondary
school
trial
role-playing
perspective
or control
school
students
within classes
taking,
group
students
problemsolving
strategies, and
social skills
8 aggressive 8 aggressive
Grades 4
Pretest,
15-wk curriculum Social
Partial
students
students
and 5
posttest,
problemrandomization:
time-lagged
solving skills;
nonaggressive
comparison
reorganization
children
of schemas for
randomly
social
placed in
information
groups of 4;
processing and
1-2 aggressive
problemchildren
solving
randomly
through
selected, added
experiential
to groups
learning
60 students 60 students (10 Aged 6 and Pretest,
Kidscape
General safety
Kids randomly
(10 from
from each of
10 y
posttest,
Childrens
rules applied
selected within
each of the
the 2 primary
randomized,
Safety Training
with specific
school groups,
2 primary
classes in each
controlled
Program
stories and role
but 3
classes in
of 6 schools)
design
curriculum
plays
intervention
each of 6
implemented
schools
schools)
over 4 wk
selected the
program

(continued)

tions are all described in Table 1. The studies all used a

pretest, posttest, control group design; 6 of the 10 studies randomized the assignment of the groups.23,29-31,35,36
The curriculum interventions did not consistently decrease bullying, and several actually suggested that the
bullying within the intervention group increased (Table 2).
Of the 10 studies of curriculum interventions, 6 showed

no significant improvements in bullying.23,26,30,32,33,36 Although bullying and victimization did not change significantly, Boulton and Flemington30 did find that the students in the intervention group broadened their definition
of bullying slightly, and Englert32 found that the teachers reported a significant decrease in observed physical
and verbal violence (P.01).

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

80

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

Table 1. Study Characteristics (cont)

Source

Country

Subjects

Control Group

Intervention
Group

Grade Level
or Age Group

Study
Design

Intervention

Multidisciplinary or Whole-School Interventions

Switzerland 319 students
8 kindergartens 8 kindergartens Kindergarten
Pretest, posttest, Whole-school
Alsaker and
in 16
(n = 152)
(n = 167)
(aged 5-7 y)
control group
approach
Valkanover,25
2001
kindergartens
design

Melton
et al,28
1998

United
States

6389 students Year 1: 28

in 39 schools
schools;
year 2:
21 schools

Menesini
et al,37
2003

Italy

293 students
in 2 middle
schools

5 classes
(n = 115)

Metzler
et al,38
2001

United
States

1403 students
in 3 middle
schools

2 schools
(n = 758)

Mitchell
et al,39
2000

Australia

38 schools,
primary and
secondary

18 schools

Olweus,22
1994

Norway

2500 students NA
in 42 primary
and secondary
schools

Rahey and
Criag,40
2002

Canada

491 students
in 2 primary
schools

Roland,41
2000

Norway

7000 students NA
in 37 primary
and secondary
schools

Sanchez
et al,42
2001

United
States

747 students
6 schools
at 12 schools
(n = 378380)

Twemlow
et al,43
2001

United
States

110 students
at 2 schools

1 school
(n = 251)

1 school
(n = 64)

Educational
Theory*

Teacher training
on
whole-school
approach with
emphasis on
rules and
social-cognitive
skills
Year 1: 11
Grades 4-6
Pretest, posttest, Whole-school
Interventions at
schools; year
(aged 9-11 y)
control group
approach
level of school,
2: 18 schools
design
curriculum,
individual
students;
materials for
school staff and
involved
community
members
9 classes
Grades 6-8
Pretest, posttest, Befriending
Training and
(n = 178)
control group
intervention
implementation
design
of peer
supporters
within schools
1 school
Grades 6-8
Pretest, posttest, Comprehensive Rule system,
(n = 645)
control group
behavior
training,
design
management
increased praise
program
systems
21 schools
Primary and
Pretest, posttest, HealthSchool staff
secondary
randomized,
promoting
workshop,
controlled
schools
resource kit for
design
intervention
school, network
meetings for
staff, financial
support for
school-based
activities
NA
Primary and
QuasiWhole-school
Teacher training,
secondary
experimental
approach
parent advice,
with
videotaped
time-lagged
curriculum,
age cohort
feedback for
staff; emphasis
on rules and
sanctions
1 school
Grades 1-8
Pretest, posttest, Whole-school
Curriculum, peer
(n = 240)
control group
program
mediation
design
implemented
program,
over 12 wk
groups for
bullies and
victims, teacher
training;
emphasis on
conflict
resolution,
empathy, and
listening skills
NA
Primary and
Age-cohort
Whole-school
Teacher training,
secondary
design with
approach
curriculum;
students
time-lagged
emphasis on
comparisons
rules and
sanctions
6 schools
Grade 5
Pretest, posttest, Whole-school
Expect Respect
(n = 362-367)
randomized,
approach
Model with
matched
classroom
pairs,
curriculum,
controlled
staff training,
design
policy
development,
and support
services for
individuals
1 school
Primary school Pretest, posttest, Whole-school
Social
(n = 46)
control group
approach
systems/
design
psychodynamic
intervention,
including zero
tolerance,
discipline plan,
physical
education plan,
and mentoring
program

Method of Group
Assignment
By school;
interested
teachers
selected
for the
intervention
Districts matched
by
demographics;
one district in
each pair
assigned to
first year of
intervention
Assigned by
class based
on teachers
willingness to
participate
Assigned by
school
Randomized by
school

Time-lagged
cohorts, not
randomized

Assigned by
school

Time-lagged
cohorts, not
randomized
6 pairs of
matched
schools,
1 school in
each pair
randomly
assigned
to the
intervention
Assigned by
school;
method
not given

(continued)

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

81

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

Table 1. Study Characteristics (cont)

Source

Country

DeRosier,44
2004

United
States

Fast et al,45
2003

United
States

Meyer and
Lesch,46
2000

South
Africa

Subjects

Control Group

Intervention
Group

Grade Level
or Age Group

Intervention

Educational
Theory*

Social and Behavioral Skills Group Training Interventions

n = 198
Grade 3
Pretest, posttest, S.S. GRIN
Social learning
randomized,
social skills
and cognitive
controlled
group training
behavioral
design
techniques

415 students
with
significant
peer
relationship
difficulties
127 students

n = 217

n = 105

n = 22 (12
Grade 7
aggressive
and 10
nonaggressive
students)

54 students at
3 schools,
all males
identified as
bullies

n = 18

Interventional
behavioral
skills group
(n = 18) and
supportive
play group
(n = 18)
n = 15

Grades 6-7

Quasi-experimental Peer mediator

Peer mediation
intervention for
group training
to improve
aggressive
individual
students only;
behavior and
no matched
affect social
control
norms
Pretest, posttest, Behavioral skills Social
randomized,
group
interactional
matched pairs
model for
with control
behavioral
design
skills
development

Grade 8

Method of Group
Assignment
Random
assignment
by student

Selected based
on aggression
level

Matched by
aggression
level, then
randomly
allocated to
experimental
condition
Students selected
if causing
concern;
matched to
control

Pretest, posttest, Social skills

Social skills
matched cohort
training group
training on
(6 sessions)
speaking/
listening,
friendships,
bullying,
knowing ones
self, and
knowing others
Other Interventions
670 students at 1 primary and 1 primary and
Primary and Pretest, posttest, Increased social Focus on family Assigned by
Bagley and United
2 primary
1 secondary 1 secondary
secondary
control group
workers
and child
school
Pritchard,48 Kingdom
1998
schools and
school
school
design
counseling and
2 secondary
on addressing
schools
bullying
49
United
311 fourth-grade Nonmentored At risk
Grade 4
Cohort study
Mentoring
Focus on
Students selected
King et al,
2002
States
students at
students
students
program twice
relationship
based on risky
1 school
(n = 283)
(n = 28)
a week
building,
health
self-esteem
behaviors,
enhancement,
depression,
goal setting,
and risk for
and tutoring
school failure
Tierney and
Dowd,47
2000

United
30 students with n = 15
Kingdom
emotional and
behavioral
concerns,
including
victimization

Study
Design

Abbreviation: NA, data not applicable.

*For multidisciplinary or whole-school interventions, components are given.

Of the 4 studies that did show less bullying after a curriculum intervention, 3 also showed more bullying or victimization in certain populations or with certain measurement tools.29,34,35 The study by Baldry and Farrington29
showed a decrease in self-reported victimization among
older children (P.05), but younger children actually reported more victimization (P.01), and there were no
significant differences in either victimization or bullying overall. Teglasi and Rothman35 found that teachers
reported decreased antisocial behavior for children not
identified as aggressive and increased aggressive behavior for the children previously identified as aggressive
(P.01 for both). The individual self-reports for aggression did not reveal any significant effects from the intervention. A study by Rican et al34 found significant decreases in peer nominations of bullying (P=.02) and
victims (P=.03) using unspecified broad criteria, but
no change in victimization using narrower criteria. Only
1 curriculum intervention showed unequivocal improvements, and this was in an indirect outcome. The randomized trial of Elliott and Faupel31 of a group problemsolving curriculum resulted in increased generation of
responses to a simulated bullying situation by the intervention group.

WHOLE-SCHOOL MULTIDISCIPLINARY
INTERVENTIONS
Ten studies22,25,28,37-43 evaluated interventions using a multidisciplinary whole-school approach that included some
combination of schoolwide rules and sanctions, teacher
training, classroom curriculum, conflict resolution training, and individual counseling. Table 1 describes the components of each of these multidisciplinary studies in detail. The whole-school studies involved more subjects than
the curriculum interventions, with up to 42 schools in a
single study. Only 2 of the studies39,41 evaluated interventions among secondary school students, and the rest
looked at primary schools. In contrast to the curriculum studies, only 2 of the whole-school studies incorporated randomization in their study design. Two of the
studies41,50 used a quasi-experimental design with timelagged age cohorts.
Two studies, both evaluating the seminal Olweus Bullying Prevention Program, revealed disparate results. The
Olweus Bullying Prevention Program pioneered the
whole-school approach to preventing and reducing bullying with an intervention program in Bergen, Norway,
that included training for school personnel, materials for

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

82

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

Table 2. Study Outcomes by Intervention Type

Source

Intervention
Type

Baldry and
Farrington,29
2004
Boulton and
Flemington,30
1996

Curriculum

Cowie et al,26
1994
Elliott and
Faupel,31 1997

Curriculum

Curriculum

Curriculum

Englert,32 1999

Curriculum

Kaiser-Ulrey,33
2003

Curriculum

Rican et al,34
1996

Curriculum

Stevens et al,23
2000

Curriculum

Teglasi and
Rothman,35
2001

Curriculum

Warden et al,36
1997

Curriculum

Alsaker and
Valkanover,25
2001

Multidisciplinary

Melton et al,28
1998

Multidisciplinary

Direct Outcomes: Bullying, Aggressive Behavior, Violence,

and School Responses to Violence
No difference in victimization or bullying overall (P = .08); less
victimization in older students (aged 14-16 y) (t = 2.19, P.05);
worse victimization for younger students (t = 2.73, P.01)
No significant change in bullying others

No significant effect on bullying behavior (increase in both groups);

small decrease in reporting of victimization
Not measured

No change from childrens reports; no statistically significant

difference for individual classrooms; control classroom students
reported significantly fewer incidents of being bullied than
problem-solving classroom students before and after the
intervention (P.01); teacher observations of significant decrease
in observed physical and verbal violence, with mean scores
decreasing from 3.40 to 1.60 (P.01) for the problem-solving
group and mean scores decreasing from 3.80 to 1.40 (P.01)
for the cooperative task group
No change; MANCOVA for outcomes of bullying incidence,
victimization incidence, prosocial behaviors, and parental
involvement revealed no significant multivariate effect between
groups; nonparametric analysis of evidence of bullying and
victimization revealed no improvement

Improvement in bullying: intervention classes had significantly fewer

bullies nominated by peers after the intervention (7.1% compared
with 11.2% using broader criterion to define bullies; P = .02);
decreased victimization by some criteria: victims defined by a
broader criterion (7.1% in intervention classes compared with
14.3% in control classes (P = .03); for narrower criterion, the
intervention group did not have a significant change in percentage
of victims, but still had a significant change in percentage of
bullies (P = .02)
No significant change for primary students in involvement in
bully-victim behaviors (P.07); no significant change for
secondary students at posttest 2
Improved for nonaggressive children; worsened for aggressive
children; teacher reports showed decreases in externalizing and
antisocial behaviors for children not identified as aggressive
(P.01) and increases in externalizing aggressive behavior for
children previously identified as aggressive (P.01); a 2 analysis
of the relationship between identification status and treatment
response indicated aggressive children were more likely to have a
low response rate (P.001); less externalizing children respond
better to treatment (P.001); individual self-reports did not reveal
any significant effects from the intervention
Not measured

No changes in teacher or child reports of bullying behavior; decreased

victimization on teacher and child reports; on peer reports, the
intervention group had a 15% reduction in the proportion of
children nominated as victims by peers in contrast with a 55%
increase in children in the control group nominated as victims;
teacher reports showed reduction in physical bullying and indirect
bullying through isolation, but an increase in verbal bullying;
neither childrens peer nominations nor teacher ratings showed
any evidence of decrease in bullying behaviors in the intervention
or control group; childrens reports in both groups showed a slight
increase in nominations of bullying (no statistics given)
After 2 y of the intervention, no significant differences in bullying,
antisocial behavior, or victimization (victimization increased in both
groups); no significant change in victimization rates in intervention
schools at year 1 or 2; intervention schools did have a decline in
the rate of bullying by 20% after the first year of the intervention
(in contrast with a 9% increase in bullying rates in the control
schools), but after 2 y of the intervention, there were no significant
differences in bullying, general antisocial behaviors, or attitudes
toward bullying between the intervention and control students; no
significant program effects for 7 original control schools that
received only 1 y of the intervention

Indirect Outcomes: School Achievement,

Perceived School Safety, Self-esteem,
and Knowledge or Attitudes About Bullying
Not measured
No significant difference in attitudes toward bullying;
did broaden definition of bullying slightly to include
name-calling (P = .40), telling nasty stories about
other people (P = .55), and forcing people to do
things they do not want to do (P.05)
Not measured
Improved generation of responses to bullying: group
interpersonal problem-solving curriculum
producing 3 times more solutions (105 responses)
than control group (32 responses)
No change; neither intervention group showed
significant improvement in problem solving vs the
control group (P.01); no significant differences in
self-esteem scores preintervention and
postintervention; cooperative task classroom
actually had significantly lower self-esteem scores
than problem-solving or control classroom
postintervention (P.05)
Improved social skills; MANCOVA for outcomes of
empathy, prosocial behaviors, global self-esteem,
and parental involvement revealed no significant
multivariate effect between the groups;
nonparametric analysis of social skills
development, talking to friends about bullying,
talking to parents about bullying, and program
success revealed no improvement, except for
improved social skills in the intervention group
(P = .01)
Not measured

No significant changes for primary or secondary

students in attitude toward bullies and victims,
self-efficacy, and intention to intervene
Not measured

No improvement in responses to bullying situation for

either 6- or 10-year-old children; for other safety
situations, responses of the intervention group
were rated as significantly more safe than those of
the untrained control group; responses of older
children were rated as significantly safer than those
of younger children on all 3 testings (P.001)
Increased awareness of school rules regarding
bullying

No differences in attitudes toward bullying

(continued)

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

83

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

Table 2. Study Outcomes by Intervention Type (cont)

Intervention
Type

Direct Outcomes: Bullying, Aggressive Behavior, Violence,

and School Responses to Violence

Menesini
et al,37
2003

Multidisciplinary

Metzler
et al,38
2001

Multidisciplinary

Bullying remained stable for the intervention group (although it

increased for the control group); no change in victim or
defendant scales; levels of bullying or probullying behaviors in
the intervention group remained stable, whereas probullying
scales increased in the control group (P.05)
Improved discipline referrals for seventh graders (P = .04);
improved harassment among males (P = .02); no changes for
sixth and eighth graders; no change in physical or verbal
attacks

Mitchell
et al,39
2000

Multidisciplinary

Not measured

Olweus,22
1994

Multidisciplinary

Rahey and
Criag,40
2002

Multidisciplinary

Roland,41
2000

Multidisciplinary

Sanchez
et al,42
2001

Multidisciplinary

Decreased level of bully-victim problems, peer reports of

bullying, and general antisocial behavior; for outcomes of
bullying others, boys averaged a 16% reduction and girls
averaged a 30% reduction after 8 mo; after 20 mo, reductions
averaged 35% for boys and 74% for girls; reductions in
victimization averaged 48% for boys after 8 mo and 58% for
girls; reductions increased to 52% for boys and 62% for girls
after 20 mo
No significant decrease in bullying; decreased level of
victimization (P.05) and peer isolation (P.01) for older
students (grades 5-8); increased level of victimization (P.05)
and exclusion (P.01) for younger students (grades 1-4)
Increase in bullying (a 24% increase in boys and a 14% increase
in girls); increased victimization in boys (by 44%); increased
social exclusion for boys (by 12.5%); more positive outcomes
for schools implementing programs fully
Not measured

Twemlow
et al,43
2001

Multidisciplinary

DeRosier,44
2004

Social skills
group

Fast et al,45
2003

Social skills
group

Meyer and
Lesch,46
2000
Tierney and
Dowd,47
2000
Bagley and
Pritchard,48
1998

Social skills
group

King et al,49
2002

Mentoring
program

Source

Improved discipline referrals and suspension rates; disciplinary

referrals decreased from 74 for physical aggressiveness in
1994-1995 to 34 after the first year of the intervention, and
stabilized at 36 during the second year of the intervention;
referrals for other infractions went from 162 to 97 after the
first year, and to 93 after the second year; suspension rates
were significantly lower in the intervention group, at about
9% after the first year (P.02) and 4% after the second year
(P.004) (the control school suspension rate did not vary
significantly, ranging between 14% and 19%)
Significantly improved aggression on peer report (P.001);
improved bullying behavior on self-report (P.05); fewer
antisocial affiliations on self-report (P.05) only for children
who were more aggressive at baseline
No significant change in discipline referrals, aggressive behavior,
or impulsivity; improved scores on teachers Behavior Rating
Index for Children for highly aggressive students, with a
difference in means of 9.05 (P.05)
No improvement in bullying on peer reports or self-reports

Social skills
group

Improved interactions with peers by teacher report;

no clear change in victimization on self-report

Increased social
workers by
2.5 workers

Improved bullying in primary school and no improvement in

secondary school; improved theft, truancy, fighting, and drug
use in primary and secondary schools (P.05); primary
project schools self-reports of bullying incidents went from
28% to 22%, a 21% decrease, with P.05 (control school
rates went from 28% to 30%, a 7% increase); secondary
intervention schools self-reported rates of bully or bullied
involvement went from 10% to 12% (a 20% increase), while
control school went from 14% to 13% (a 7% decrease)
Improved bullying and fighting; at posttest, mentored students
were significantly less likely to have bullied a peer in the past
30 d (t 27 = 3.47, P.002) and to have physically fought with a
peer in the past 30 d (t 27 = 3.48, P.001) than at pretest
(results not compared with the control group)

Indirect Outcomes: School Achievement,

Perceived School Safety, Self-esteem,
and Knowledge or Attitudes About Bullying
No decrease in provictim attitudes as seen in the control
group

Improved perception of safety for sixth graders

(59.3%-75.6% at the first year to 72.2% at the second
year) and seventh graders (56.4%-60.2% at the first year
to 69% at the second year); no change for eighth graders,
nor in the comparison school
Improved awareness of health-promoting school concept
with significantly greater proportion of staff hearing of
health-promoting school concept (P = .04), reading
relevant material (P.001), and attending in-service
training on health-promoting schools (P.001); no
significant changes in health-related policies or practices
occurred in the intervention group, including those related
to bullying
Improved, with better social climate and satisfaction with
the school

Improved perception of school safety (P.01) and being well

liked (P.001) for older students (grades 3-8); worsened
perception of school safety (P.01) and of being well liked
(P.01) for younger students (grades 1-2)
Not reported

No significant increase in knowledge of bullying; intervention

students more likely to report seeing bullying (P.05) and
expressed greater readiness to intervene personally
(P.05); intervention students were less likely to tell an
adult about bullying (P.05)
Improved academic achievement scores (from 40th to 58th
percentile for third and fifth graders), whereas the control
school did not change over the same period

Improved peer liking (P.05); improved self esteem

(P.05); improved self-efficacy (P.05); improved social
anxiety (P.05) for all children in the treatment group;
significant multivariate main effect for treatment condition
(P.05)
Improved self-concept for highly aggressive students by an
average of 11.33 points (P.05), while the remainder of
the class had a declining self-concept (P.05)
Not measured
Decreased level of teacher worry; significant progress in
areas of friendships and behavior on teacher reports, but
no significant change in level of happiness or confidence
Not measured

Less depression (t27 = 2.97, P = .006); significant

improvements in mentored students overall self-esteem,
school connectedness, peer connectedness, and family
connectedness; compared with control group children,
the mentored group achieved significantly higher school
connectedness and family connectedness, but self-esteem
and peer connectedness did not differ significantly; of the
28 students in the program, 20 (71%) showed academic
letter-grade improvements from the first quarter

Abbreviation: MANCOVA, multiple analysis of covariance.

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

84

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

parents, a videotaped classroom curriculum, and evaluation through the bullying questionnaire developed by
Olweus.50 By using unspecified composite measures involving student questionnaires and teacher ratings, the
follow-up evaluation found decreased bullying, decreased victimization, decreased antisocial behavior, and
improved school climate after the intervention.22,51 Evaluation of the nationwide Olweus Bullying Prevention Program in Rogaland, Norway, revealed strikingly different
results. Roland27,41 reported increased victimization and
social exclusion for boys, and increased bullying for boys
and girls based on student self-reports. Unlike in Olweus protocol, the schools in this sample did not interact with the researchers during the intervention. The
schools degree of involvement in the program was directly related to positive effects from the antibullying program, particularly for girls. Although the evaluations apparently involved the same nationwide campaign and
evaluation tools, Olweus states that they were completely different in terms of planning, data quality, times
of measurement, and contact with the schools.3(p39)
Since the publication of the study by Olweus,51 interventions targeting the whole school have been implemented in several other countries. Overall, these
whole-school studies had positive effects on bullying.
Of the additional 8 studies, 7 revealed positive outcomes.25,37-40,42,43 Five of these studies25,37,38,40,43 reported
decreases in bullying or victimization. Among kindergarteners, Alsaker and Valkanover25 found decreased victimization on teacher and student reports, although there
was no significant change in bullying on either student
nominations or teacher ratings. An Italian schoolwide peer
support intervention prevented some of the increased
negative behaviors and attitudes reported in the control
group on student reports.37 Examining administrative office records, Metzler et al38 found decreased discipline
referrals (P=.04) and harassment (P=.02) in select populations after 2 years of implementing a schoolwide behavioral management program. However, student reports of physical and verbal attacks did not significantly
change. Twemlow et al43 found decreased disciplinary referral rates, decreased suspension rates, and increased
achievement test scores after a schoolwide intervention.
In their evaluation of a 12-week schoolwide program, Rahey and Criag40 found mixed results. On peer and selfreports, the students in grades 5 through 8 had decreased victimization (P.05) and decreased peer isolation
(P.01) compared with the controls.40 In contrast, the
younger students reported increased levels of victimization (P.05) and increased exclusion (P.01).40 In addition, neither student nor teacher reports showed a significant decrease in bullying for any age group.
Two of the studies39,42 that revealed improvements after a multidisciplinary intervention only measured outcomes indirectly related to bullying. Some of the indirect
outcomes were positively affected, but others remained unchanged. The evaluation by Sanchez et al42 indicated no significant increase in knowledge of bullying, but the intervention students were more likely to report seeing bullying
and to express readiness to intervene personally (P.05
for both). A randomized controlled trial39 evaluating an intervention to develop health-promoting schools re-

vealed an increased awareness of health-related policies and

practices among school administrators after the intervention (P=.04). No significant changes in health-related policies or practices occurred in the intervention group, including those related to bullying.
The other evaluation of a whole-school intervention that
we identified revealed no significant decreases in bullying.
Melton et al28 implemented an intervention based on the
Olweus Bullying Prevention Program in 6 rural school districts in South Carolina. After 2 years, they found no significant differences in student self-reports of bullying, victimization, general antisocial behaviors, or attitudes toward
bullying between the intervention and control students.
SOCIAL AND BEHAVIORAL SKILLS GROUP
TRAINING INTERVENTIONS
Four studies44-47 looked at targeted interventions involving social and behavioral skills groups for children involved in bullying. Two of these interventions specifically targeted children with high levels of aggression,45,46
while the other 2 targeted children who were themselves victims.44,47 Of the 4 studies, 3 focused on older
students, in sixth through eighth grades,45-47 while the
fourth looked at third-grade students.44 The most positive outcomes occurred for the youngest students.44
DeRosier44 tested the efficacy of social skills group training for third-grade students with peer relationship
difficulties in 11 public primary schools in North Carolina. The intervention resulted in decreased aggression
on peer reports (P.001), decreased bullying on selfreports (P.05), and fewer antisocial affiliations on selfreports (P.05) for the previously aggressive children. This
was the only social skills training intervention that showed
clear reductions in bullying from the intervention.
The other social skills group interventions, all of which
involved older children, did not result in clear changes.
Meyer and Lesch46 evaluated a behavioral skills modification program for boys identified as bullies in South Africa.
This intervention did not produce any statistically significant decrease in bullying behaviors by peer report or selfreport. Fast et al45 examined whether group training in peer
mediation for aggressive seventh graders would reduce their
level of aggression. The aggressive students in the intervention group had a significant decrease in their problem
behaviors as measured by their teachers (P.05); however, no significant changes in disciplinary referrals for aggressive behavior or impulsivity scores occurred. Tierney
and Dowd47 used social skills group training for eighthgrade girls with emotional and behavioral concerns. Although the teacher data indicated statistically significant
progress in the areas of friendships, behavior, interactions
with peers, and level of teacher concern, the data and analysis were not given within the article. Data from the pupil
questionnaires were not analyzed, but in student selfreports, 8 reported no difference in victimization and 7 reported improvement.
OTHER INTERVENTIONS
A single study, done by Bagley and Pritchard,48 examined the effects of an increase in the number of school

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

85

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

social workers focused on problem behaviors, including bullying. Compared with matched control schools,
they found a significant decrease in self-reported bullying within the primary school (P.05), but worsening
bullying in the secondary school. For self-reports of theft,
truancy, fighting, and drug use, the primary and secondary intervention schools had significant improvements
(P.05). A study by King et al49 investigated the effects
of a mentoring program for at-risk children. The mentored students were significantly less likely than their nonmentored age-matched peers to report bullying (P.002),
physically fighting (P.001), and feeling depressed
(P=.006) in the past 30 days.
COMMENT

As governments, schools, and educators invest increasing amounts of money and time into antibullying interventions, the findings of this review provide evidence for
how to best achieve the desired outcome of decreased bullying within schools. By systematically gathering and compiling the growing number of studies evaluating these interventions, it becomes clear that some of the antibullying
interventions actually decrease bullying, while others have
no effect or even seem to increase the amount of bullying. Grouping the studies by the type of intervention seems
to offer the most insight into what leads to success.
The curriculum interventions were generally designed to promote an antibullying attitude within the classroom and to help children develop prosocial conflict resolution skills. Most of these interventions drew on the social
cognitive principles of behavioral change,52,53 with focus on changing students attitudes, altering group norms,
and increasing self-efficacy. Curriculum changes are
often attractive because they usually require a smaller commitment of resources, personnel, and effort. Nevertheless, the interventions that consisted only of classroomlevel curriculum seldom improved bullying. The basis
in social, cognitive, behavioral change may explain part
of the problem; previous work54,55 suggests that younger
children benefit less from these techniques. However, the
failure of classroom-level interventions for older and
younger students points to the systemic nature of bullying and supports the theory of bullying as a sociocultural phenomenon. If bullying is a systemic group
process involving bullies, victims, peers, adults, parents, school environments, and home environments,56 an
intervention on only 1 level is unlikely to have a significant consistent impact. Furthermore, if bullying is, as some
propose, a sociocultural phenomenon springing from the
existence of specified social groups with different levels
of power,57 then curriculum aimed at altering the attitudes and behaviors of only a small subset of those groups
is unlikely to have an effect.
Similarly, the targeted interventions providing training in social skills did not clearly improve bullying or victimization.45-47 The failure of these interventions, also
based largely on social, cognitive, behavioral changes,
points again to the inability of a single-level intervention to combat bullying effectively. Interestingly, the older
children had worse outcomes from the social skills train-

ing groups than the younger children.44 The 1 study looking at younger children found decreased aggression, bullying, and antisocial affiliations. Although one cannot
generalize from a single study, it is possible that addressing social skills changes in the context of a small targeted group during a particular developmental window
could be effective. Overall, the studies of social skills group
interventions suggest again that failing to address the systemic issues and social environment related to bullying
undermines success.
The whole-school interventions, which included multiple disciplines and complementary components directed at different levels of the school organization, more
often reduced victimization and bullying than the interventions that only included classroom-level curricula or
social skills groups. The whole-school interventions address bullying as a systemic problem meriting a systemic solution. They seek to alter the schools entire environment and to involve individuals, peer groups,
classrooms, teachers, and administration. The success of
the whole-school interventions suggests that bullying
does, indeed, spring from factors external to individual
childrens psychosocial problems, including a complex
process of social interactions. An evaluation of wholeschool approaches by Smith et al56(p557) in 2004 suggests
that these interventions may reflect a reasonable rate of
return on the investment inherent in low-cost, nonstigmatizing primary prevention programs. Our review offers further support for using whole-school interventions to reduce or prevent bullying.
Despite the evidence pointing toward the value of
whole-school approaches, significant barriers may still
limit their effectiveness. The implementation of the intervention can vary significantly, and this clearly alters
the results. The original antibullying whole-school approach studied in Bergen by Olweus51 and the evaluation of the same program in Rogaland by Roland27,41 produced the most strikingly disparate results. The contrast
may have been the result of decreased school staff participation at the Rogaland schools.27 In addition, the Olweus program does not include detailed instructions for
replicating an identical program in another school setting. Difficulty in replicating this program may contribute to the lack of success when used in other settings,
such as South Carolina.28 Although the adaptation of the
interventions in different settings may create more culturally appropriate interventions, these modifications may
produce some of the variance in success. Unfortunately,
the specific components of a given intervention are generally not described sufficiently to enable faithful replication. The specific school environment could also significantly impact effectiveness. The small class size,
excellent teacher training, and tradition of social welfare intervention in some settings could enable better effects. The suggestion that whole-school interventions may
not work as well for younger children, seen in 2 of the
studies,25,40 also merits consideration. This, albeit limited, evidence may support a developmental theory,
whereby bullying begins in early childhood as individuals assert themselves to gain dominance and then gradually evolves as children use less socially reprehensive ways
to dominate others.58 Schoolwide rules and changes in

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

86

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

the schools overall responses to bullying may not be as

effective in the younger population before they follow their
natural developmental progression into conformity with
social norms.
There are several limitations to this systematic review that warrant consideration. We only included studies in the English language. Although we may have, therefore, overlooked some relevant studies, we located few
nonEnglish-language studies that required exclusion.
Some of the included studies did not have ideal methodological strength; however, many of the studies were
reasonably well done and offered important counterbalances to the findings. The study results may be overestimated because, in many cases, schools or districts were
randomized to treatment conditions, but the students were
evaluated as the unit of analysis. The unit of analysis problem could result in a higher type I error if intraclass correlation is not taken into account.59 Even so, many of the
studies that did this still found no treatment effects. The
use of variable outcome measures may further limit the
ability to measure accurately the effects of these interventions. The most common outcome measures were selfreports of victimization and bullying that may not wholly
correspond with information obtained from peers or
teachers or from observations.60 Still, self-reports are the
standard measure used in most studies evaluating behavioral interventions. Despite the diversity of the evidence reviewed, the studies were primarily performed in
Europe and the United States, which may limit the generalizability of the conclusions. In addition, several interventions with positive results, including interventions using mentoring, increased social workers by 2.5
workers, and social skills groups for younger children, were
only studied on a single occasion, thus limiting their generalizability. Finally, while we attempted to separate out
the most effective components or intervention strategies,
many of the studies involved numerous complementary
components that were not evaluated individually.
In conclusion, fairly consistent evidence suggests that
childrens bullying behavior can be significantly reduced
by well-planned interventions. The chance of success is
greater if the intervention incorporates a whole-school approach involving multiple disciplines and the whole school
community. The school staffs commitment to implementing the intervention also may play a crucial role in its success. The use of curriculum or targeted social skills groups
alone less often results in any decrease in bullying and sometimes worsens bullying and victimization. Caution should
be exercised in supposing that antibullying interventions
invariably produce the intended results. This review reveals that not all programs have proved effective. Most reductions in bullying tend to be relatively small and related
more to the proportion of children being victimized rather
than the proportion engaging in bullying. Additional research to evaluate bullying behaviors and antibullying interventions is clearly needed.
Accepted for Publication: August 3, 2006.
Correspondence: Rachel C. Vreeman, MD, Childrens
Health Services Research, Indiana University School of
Medicine, 699 West Dr, Riley Research Room 330, Indianapolis, IN 46202 (rvreeman@iupui.edu).

Author Contributions: Dr Vreeman had full access to all

the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Vreeman and Carroll. Acquisition of data: Vreeman. Analysis and interpretation of data:
Vreeman and Carroll. Drafting of the manuscript: Vreeman. Critical revision of the manuscript for important intellectual content: Vreeman and Carroll. Statistical analysis: Vreeman and Carroll. Administrative, technical, and
material support: Vreeman and Carroll. Study supervision: Vreeman and Carroll.
Financial Disclosure: None reported.
Disclaimer: The views expressed herein are those of the
authors and do not necessarily represent the views of Indiana University School of Medicine.
REFERENCES
1. Glew G, Rivara F, Feudtner C. Bullying: children hurting children. Pediatr Rev.
2000;21:183-190.
2. Olweus D. Bullying at school: basic facts and an effective intervention programme.
Promot Educ. 1994;1:27-31, 48.
3. Olweus D. Sweden; Norway. In: Smith PKMY, Junger-Tas J, Olweus D, Catalano
R, Slee P, eds. The Nature of School Bullying: A Cross-national Perspective. New
York, NY: Routledge; 1999:7-48.
4. Williams K, Chambers M, Logan S, Robinson D. Association of common health
symptoms with bullying in primary school children. BMJ. 1996;313:17-19.
5. Rigby K. Peer victimisation at school and the health of secondary school students.
Br J Educ Psychol. 1999;69(pt 1):95-104.
6. Dake JA, Price JH, Telljohann SK. The nature and extent of bullying at school.
J Sch Health. 2003;73:173-180.
7. Kaltiala-Heino R, Rimpela M, Marttunen M, Rimpela A, Rantanen P. Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ. 1999;
319:348-351.
8. Salmon G, James A, Smith DM. Bullying in schools: self reported anxiety, depression, and self esteem in secondary school children. BMJ. 1998;317:924925.
9. Kaltiala-Heino R, Rimpela M, Rantanen P, Rimpela A. Bullying at school: an indicator of adolescents at risk for mental disorders. J Adolesc. 2000;23:661674.
10. Olweus D. Victimization by peers: antecedents and long-term outcomes. In: Rubin K, Asendorf JB, eds. Social Withdrawal, Inhibition, and Shyness in Children.
Hillsdale, NJ: Lawrence A Erlbaum Associates; 1993:315-341.
11. Brown SL, Birch DA, Kancherla V. Bullying perspectives: experiences, attitudes,
and recommendations of 9- to 13-year-olds attending health education centers
in the United States. J Sch Health. 2005;75:384-392.
12. Eisenberg ME, Neumark-Sztainer D, Perry CL. Peer harassment, school connectedness, and academic achievement. J Sch Health. 2003;73:311-316.
13. Hazler RJ, Hoover J, Oliver R. What children say about bullying. Executive Educator.
1992;14:20-22.
14. Kochenderfer BJ, Ladd GW. Peer victimization: cause or consequence of school
maladjustment? Child Dev. 1996;67:1305-1317.
15. Mynard H, Joseph S. Bully/victim problems and their association with Eysencks
personality dimensions in 8 to 13 year-olds. Br J Educ Psychol. 1997;67:51-54.
16. Glew GM, Fan MY, Katon W, Rivara FP, Kernic MA. Bullying, psychosocial adjustment, and academic performance in elementary school. Arch Pediatr Adolesc Med. 2005;159:1026-1031.
17. Juvonen J, Nishina A, Graham S. Peer harassment, psychological adjustment,
and school functioning in early adolescence. J Educ Psychol. 2000;92:349359.
18. Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, Scheidt P. Bullying behaviors among US youth: prevalence and association with psychosocial
adjustment. JAMA. 2001;285:2094-2100.
19. Perry D, Kusel S, Perry L. Victims of peer aggression. Dev Psychol. 1988;24:807814.
20. Smith PK, Ananiadou K, Cowie H. Interventions to reduce school bullying. Can J
Psychiatry. 2003;48:591-599.
21. Olweus D. Bullying at School: What We Know and What We Can Do. Cambridge,
Mass: Blackwell Publishers Ltd; 1993.
22. Olweus D. Bullying at school: basic facts and effects of a school based intervention program. J Child Psychol Psychiatry. 1994;35:1171-1190.

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

87

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014

23. Stevens V, De Bourdeaudhuij I, Van Oost P. Bullying in Flemish schools: an evaluation of anti-bullying intervention in primary and secondary schools. Br J Educ
Psychol. 2000;70:195-210.
24. Balk EM, Bonis PA, Moskowitz H, et al. Correlation of quality measures with estimates of treatment effect in meta-analyses of randomized controlled trials. JAMA.
2002;287:2973-2982.
25. Alsaker FD, Valkanover S. Early diagnosis and prevention of victimization in
kindergarten. In: Juvonen J, Graham S eds. Peer Harassment in School. New
York, NY: Guilford Press; 2001:175-195.
26. Cowie HS, Smith PK, Boulton M, Laver R. Cooperation in the Multi-Ethnic Classroom.
London, England: David Fulton; 1994.
27. Roland E. Bullying: a developing tradition of research and management. In: Tattum DP, ed. Understanding and Managing Bullying. Oxford, England: Heinemann Educational; 1993:15-30.
28. Melton GB, Limber SP, Cunningham P, et al. Violence Among Rural Youth. Washington, DC: Office of Juvenile Justice and Delinquency Prevention; 1998.
29. Baldry AC, Farrington DP. Evaluation of an intervention program for the reduction of bullying and victimization in school. Aggress Behav. 2004;30:1-15.
30. Boulton MJ, Flemington I. The effects of a short video intervention on secondary school pupils involvement in definitions of and attitudes towards bullying.
Sch Psychol Int. 1996;17:331-345.
31. Elliott H, Faupel A. Childrens solutions to bullying incidents. Educ Psychol Pract.
1997;13:21-28.
32. Englert D. Investigating the Effectiveness of Violence Intervention in a Primary
Education Setting: A Comparison of Programs [dissertation]. University: University of Mississippi; 1999.
33. Kaiser-Ulrey C. Bullying in Middle School: A Study of B.E.S.T.Bullying Eliminated From Schools TogetherAn Anti-Bullying Program for Seventh Grade
Students. Tallahassee: Florida State University College of Education; 2003.
34. Rican P, Ondrova K, Svatos J. The effect of a short, intensive intervention upon
bullying in four classes in a Czech town. Ann N Y Acad Sci. 1996;774:399400.
35. Teglasi H, Rothman L. STORIES: a classroom-based program to reduce aggressive behavior. J Sch Psychol. 2001;39:71-94.
36. Warden D, Moran E, Gillies J, Mayes G, Macleod L. An evaluation of a childrens
safety training programme. Educ Psychol. 1997;17:433-449.
37. Menesini E, Codecasa E, Benelli B, Cowie H. Enhancing childrens responsibility
to take action against bullying: evaluation of a befriending intervention in Italian
middle schools. Aggress Behav. 2003;29:1-14.
38. Metzler C, Biglan A, Rusby J, Sprague J. Evaluation of a comprehensive behavior management program to improve school-wide positive behavior support. Educ
Treat Child. 2001;24:448-479.
39. Mitchell J, Palmer S, Booth M, Powell Davies G. A randomised trial of an intervention to develop health promoting schools in Australia: the south western Sydney study. Aust N Z J Public Health. 2000;24:242-246.
40. Rahey L, Criag W. Evaluation of an ecological program to reduce bullying in schools.
Can J Counseling. 2002;36:281-296.
41. Roland E. Bullying in school: three national innovations in Norwegian schools in
15 years. Aggress Behav. 2000;26:135-143.
42. Sanchez E, Robertson T, Lewis C, Rosenbluth B, Bohman T, Casey D. Preventing bullying and sexual harassment in elementary schools: the Expect Respect

43.

44.

45.
46.

47.
48.

49.

50.

51.

52.
53.
54.

55.

56.

57.
58.
59.
60.

model. In: Geffner R, Loring M, Young C, eds. Bullying Behavior: Current Issues, Research, and Interventions. Vol 2. New York, NY: Haworth Maltreatment
& Trauma Press; 2001:157-180.
Twemlow SW, Fonagy P, Sacco FC, Gies ML, Evans R, Ewbank R. Creating a
peaceful school learning environment: a controlled study of an elementary school
intervention to reduce violence. Am J Psychiatry. 2001;158:808-810.
DeRosier ME. Building relationships and combating bullying: effectiveness of a
school-based social skills group intervention. J Clin Child Adolesc Psychol. 2004;
33:196-201.
Fast J, Fanelli F, Salen L. How becoming mediators affects aggressive students.
Child Sch. 2003;25:161-171.
Meyer N, Lesch E. An analysis of the limitations of a behavioral programme for
bullying boys from a subeconomic environment. S Afr J Child Adolesc Ment Health.
2000;12:59-69.
Tierney T, Dowd R. The use of social skills groups to support girls with emotional difficulties in secondary schools. Support Learning. 2000;15:82-85.
Bagley C, Pritchard C. The reduction of problem behaviours and school exclusion in at-risk youth: an experimental study of school social work with costbenefit analyses. Child Fam Soc Work. 1998;3:219-226.
King KA, Vidourek RA, Davis B, McClellan W. Increasing self-esteem and school
connectedness through a multidimensional mentoring program. J Sch Health.
2002;72:294-299.
Olweus D. Victimization among schoolchildren: intervention and prevention. In:
Albee G, Bond L, eds. Improving Childrens Lives: Global Perspectives on Prevention. Thousand Oaks, Calif: Sage Publications; 1992:279-295.
Olweus D. Bullying among schoolchildren: intervention and prevention. In: Peters RD, McMahon RJ, Quinsey VL, eds. Aggression and Violence Throughout
the Life Span. London, England: Sage Publications; 1992:100-125.
Conner M, Norman P. Predicting Health Behaviour. Buckingham, England: Open
University Press; 1995.
Bennett P, Murphy S. Psychology and Health Promotion. Buckingham, England:
Open University Press; 1997.
Winkel FW, Baldry AC. An application of the Scared Straight principle in early
intervention programming: three studies on activating the others perspective in
pre-adolescents perceptions of a stepping-stone behaviour. Issues Criminological Leg Psychol. 1997;26:3-15.
Baldry AC, Winkel FW. Early prevention of delinquency. In: Traverso GB, Bagnoli
L, eds. Psychology and Law in a Changing World. London, England: Routledge;
2001:35-50.
Smith JD, Schneider BH, Smith PK, Ananiadou K. The effectiveness of wholeschool antibullying programs: a synthesis of evaluation research. School Psych
Rev. 2004;33:547-560.
Rigby K. Addressing bullying in schools: theory and practice. Trends Issues Crime
Criminal Justice. 2003;259:1-6.
Hawley PH. The ontogenesis of social dominance: a strategy-based evolutionary perspective. Dev Rev. 1999;19:97-132.
Rooney BL, Murray DM. A meta-analysis of smoking prevention programs after
adjustment for errors in the unit of analysis. Health Educ Q. 1996;23:48-64.
Pellegrini A, Bartini M. An empirical comparison of methods of sampling aggression and victimization in school settings. J Educ Psychol. 2000;92:360-366.

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161, JAN 2007

88

WWW.ARCHPEDIATRICS.COM

2007 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ on 11/23/2014